Reimbursement Analyst II
2 months ago
Reimbursement Analyst II position performs work for the Chief Financial Officer Division, Provider Finance Department under the supervision of the Manager of the Hospital Rates Team. Performs advanced technical work in the development of reimbursement rates or supplemental payments and administration of certain financial programs for Medicaid and other programs under limited direction and with considerable latitude for the use of initiative and independent judgment.
Duties include:
Participation in the payment or rate development process including designing cost surveys and instructions; conducting complex data analysis to determine and evaluate payment rates; conducting public rate hearings; administering financial programs and providing technical assistance to contracted providers and auditors. Manages the development and implementation of reimbursement methodologies and payment rates; provides effective planning, organization, and guidance to staff; analyzes cost report information. Develops, modifies, and maintains complex computer programs, spreadsheets and large databases used in payment rate analysis and supplemental payment calculation. Develops policy guidelines, agency rules, state plan amendments and other associated documents relating to payment rate determination.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy.
Manages the development and implementation of complex data analysis to determine payment rates for Medicaid and other programs. Develops, modifies and maintains complex computer programs, spreadsheets and large databases used in rate and/or payment analysis. (25%)
Provides advanced technical guidance, effective planning, organization and direction to staff in the department to meet internal, legislative, State and/or Federal requirements. (20%)
Communicates complex information to internal and external parties to provide, exchange or verify information, answer inquiries address issues or resolve problems or complaints. Interfaces with various contracted providers, provider representatives, client advocates, other agency staff, advisory committees, workgroups, attorneys and other interested parties concerning payment rate policy issues affecting program delivery and payment rate determination. (20%)
Develops department policies and procedures as the subject matter expert for the team and processes policy documents (including but not limited to policy guidelines, agency rules, state plan amendments, council and advisory committee items, workgroup materials, and hearing and other notices). (15%)
Develops and/or conducts surveys to collect cost data for use in payment analysis. Designs cost data collection instruments and detailed instruction manuals to collect cost data for feasibility of use in payment rate analysis. Provides technical assistance related to cost survey completion, policy guidelines and rule requirements. (10%)
Performs other work assigned or required to maintain and support the office and HHSC operations. (10%)
Knowledge Skills Abilities:
a. Knowledge of health and human service programs, services, and procedures.
b. Knowledge of accounting, business and management principles, practices, and procedures.
c. Knowledge of state and federal laws and regulations relating to Medicaid reimbursement and public administration.
d. Ability to analyze laws, regulations, program policies, and issues.
e. Ability to develop, evaluate, implement, and interpret policies, procedures, and rules.
f. Ability to apply complex analytical applications.
g. Knowledge of reimbursement methods and payment fees, formulas, and procedures.
h. Ability to development, implement, and apply reimbursement methodologies and payment rates.
i. Skill in the use of personal computers and to use word processing, spreadsheet, statistical and other software to develop payment rates.
j. Ability to work under limited supervision, exercise independent judgment, set priorities, meet deadlines, and adapt to shifting technical and political developments.
k. Ability to manage projects effectively and produce quality work within short deadlines.
l. Ability to identify problems, evaluate alternatives, and develop creative solutions.
m. Skill in interpersonal relationships and in establishing and maintaining effective working relationships.
n. Ability to communicate effectively both orally and in writing with a variety of agency staff, medical/provider associations, client advocates, legislative staff, lawyers, state/federal auditors, and interested parties on Medicaid reimbursement issues.
o. Ability to prepare well-written briefing documents and reports designed to convey complex detailed concepts.
p. Ability to learn and teach complex, detailed concepts.
q. Knowledge of the Texas legislative appropriations process
r. Knowledge of the HHSC rules process and procedures
s. Knowledge of the HHSC Executive Memorandum and Correspondence style guide
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